OPOP conference, September 03 09, Ottawa. Telepsychiatry in a private practice setting. I, Hugues Richard, perceive no conflict of interest with this presentation but present companies with which I have worked and consulted for: Lundbeck Canada Ontario Telemedicine Network (OTN). Disclosure….
I, Hugues Richard, perceive no conflict of interest with this presentation but present companies with which I have worked and consulted for:
2. Find out which patients do best, and if there are any contraindications.
3. Discuss the future of telepsychiatry and ways it can be improved.learning Objectives
My practice: general psychiatry, adult, psychotherapy, trauma work, consultation liaison, community psychiatry
Private office: Stittsville.
Meet my two assistants…introduction
to lose control on appointments, psychotherapy even meditation!
To lack efficacy or accountability,
To become impersonal,
To be left to my own self.apprehensions
How is it going to work for new patients? psychotherapy even meditation!
Will I survive working 5 days in a row?
How are the patients and staff going to react to this?Apprehensions
Smooth process: booking, liaison; psychotherapy even meditation!
Professionalism and reliability;
Excellent technical support on line (bridge), and in vivo;My experience
NORTH you need to speak to your assistant:
1 patient declined, preferring to wait to see me in vivo
Negative perception from one agency clinical director who thought I was less availableMy experience
Convenience you need to speak to your assistant
Safety ( pandemic, road accidents…)Benefits - physician
Environment (↡carbon footprint) you need to speak to your assistant
No disruption in family life
Available to my in vivo practiceBenefits-physician
SOME PATIENTS WILL SPECIFICALLY PREFER TELEPSYCHIATRY you need to speak to your assistant
1.Distance is perceived as protective
2. Control is maintained, can walk out easily
3. Neutral place
4. Those who enjoy technology or like noveltyBenefits - patients
65 to 75% of patients who could have benefited from telemedicine chose one-to-one visits.
Different with patients from the North: all but one have used OTN.My experience
Patients’ satisfaction close to one on one visits. telemedicine chose one-to-one visits.
More qualitative studies needed to support this.What do studies tell?
Very accurate compare to in vivo telemedicine chose one-to-one visits.
The non verbal communication lacks compare to the verbal
Most studies show that the “main obstacles to telepsychiatry have to do with physicians and patients adjusting…”What do Studies tell ?
Delay to get a studio available; turn around between one and two weeks, at least 48 hrs
Registration at an agency makes it more public
Having other people involved makes it very hard for some patients to trust (bridge, hackers, OTN = government)Limitations
I had two weeks, at least 48 hrsnot anticipated this one!
Progress notes written on same lap top I use on site; two weeks, at least 48 hrs
Consultations dictated to and transcribed by my assistant →notes sent rapidly to everyone involvedCharting –my solution
Would you have offered her videoconference?
She chose….MRs. C.
Violent / unstable / impulsive patients
Patients requiring special monitoring when not availableContraindications
Patients with specific symptomatology that could be exacerbated by the use of communication technology (Z with hallucinations for instance)Contraindications
Patients with whom news must be shared in person, because it could cause significant emotional reactions (HIV test results)
Patients who have hearing, visual, cognitive deficits that limit their ability to communicate via this technologyContraindications
In her30s could cause significant emotional reactions (HIV test results)
Referred to me by FP and SW for symptoms of depression and anger
SW attends the session
I have completed the assessment, at least that’s what I thought… But apparently not her!Clinical vignette 2 –Ms. D.
Starts throwing chairs around, could cause significant emotional reactions (HIV test results)
Screams that she’s had it; nobody listens to her, and she is to kill herself
SW is hysterical
Me too !!!Clinical vignette 2 –Ms. D.
Have phone and fax very close by if not in the studio could cause significant emotional reactions (HIV test results)
Have certification forms at hand
Have a coordinator of care on site
Have triage done beforehand
Patient = realistic expectations
Good rapport with ER staffWhat have I learned ?
Telemedicine equipment recently installed in my office allows for weekly intensive sessions.
Also use of Skype (once) and numerous emails.
I talk with his SunLife case manager on phoneClinical vignette
Presently back to work full time Rescue remedy (BACH flowers)
No need for hospitalization
His wife is still with himClinical vignette –Mr. F.
Telepsychiatry is very valuable in many different ways Rescue remedy (BACH flowers)
It has shown that it is an accurate way to assess and treat patients;
It offers psychiatric services to people who have no direct access to such servicesREcapitulation
For some patients, it’s their preferred way of treatment Rescue remedy (BACH flowers)
It is not for psychiatric emergencies
It is not to replace one on one sessions
It might be a cost saving treatment
Obstacles are mostly from professionalsrecapitulation
To me, it is an exciting way to practice; Rescue remedy (BACH flowers)
Without telemedicine, I would not have been able to serve the northern communities last winter.Recapitulation
Need to know more about who are the best candidates Rescue remedy (BACH flowers)
Contraindications to be more precisely definedFuture
A must: verbal communication.
“Telehealth-clinical guideline and technical standards for telepsychiatry”,
Gilles Pineau, Khalil Mogadem, Carole St-Hilaire, Eric Levac, Bruno Hamel et al. (AETMIS 06-01) Montreal AETMIS 2006 xxii-72p.Bibliography